Chapter Text
The fluorescent lights in the emergency room hum softly above your head, blending with the distant beeping of the cardiac monitors and the murmur of voices coming from the intensive care units.
It's past midnight, but the emergency department at County General never really sleeps.
It only slows down for a brief moment before chaos reigns supreme once again.
You rub your eyes with the back of your gloved hand as you flip through a patient's medical record resting on the counter.
Mild abdominal pain. Vital signs stable. Probably nothing urgent.
You take a few notes; your handwriting is slightly uneven after hours of work.
“Hey.”
You don't even need to turn around.
“Long night?” John Carter asks in a low voice.
You turn to look at him. He's leaning against the nurses' counter, his white coat slightly crumpled, his stethoscope hanging loosely around his neck.
His hair is more disheveled than usual, and he has a slight crease between his eyebrows, the one that always appears when he's tired but tries not to show it.
“You have no idea,” you reply, exhaling slowly.
“Three admissions in the last hour. One case of suspected appendicitis, one of dehydration, and a guy who swears he's allergic to gravity.”
Carter lets out a quiet chuckle.
“Something similar happened to me last week. In the end, it turned out he was just drunk.”
You smile in spite of yourself.
With him, everything had always been easy.
Ever since your first day of residency, when you were both awkward in your oversized white coats, pretending to understand more than you actually knew.
Since then, you've taken different paths – different rotations, different residencies – but somehow, you've both ended up here.
The emergency department.
The same noise.
The same exhaustion.
The same adrenaline rush.
And John Carter.
Still John Carter.
You push that thought away and close the chart.
“Any chance I could get a coffee?” you ask.
“I've already brought you some,” he says, holding up two paper cups.
You take one; your fingers briefly brush against his. The contact is accidental.
Harmless. But you still feel that it lingers longer than it should.
Before you can say anything else, the doors to the ambulance depot swing open.
“TRAUMA COMING IN!”
Everything changes in an instant.
A stretcher bursts through the doors; the paramedics move quickly.
Blood.
A young man.
Oxygen mask.
Cervical collar.
“Male, approximately twenty-five years old,” reports a paramedic.
“High-speed car accident. Driver. Airbags deployed. Found unconscious.
Systolic blood pressure 90, heart rate 132, shallow breathing.”
You and Carter exchange a quick glance.
Then we get going.
“Let's move him to Trauma Bay 2,” Carter says.
You move to the opposite side of the stretcher. “On three. One, two…”
The patient's transfer goes smoothly.
“Airway?” Carter asks.
“Compromise,” you reply. “She's not protecting him.”
“Let's proceed with intubation.”
You grab the laryngoscope while Carter positions himself at the patient's head.
“Etomidate, 20 milligrams. Succinylcholine, 100,” you say.
Halen prepares the medications.
“Medications have been administered,” she says.
The patient relaxes. Carter moves quickly, inserting the blade.
“Vocal cords visualized… tube… 7.5… inches.”
The cuff is inflated.
“Tube secured,” she confirms.
“Take him.”
The chest rises.
“Breathing is regular,” you say, auscultating. “No obvious pneumothorax.”
“Let's get two large-bore IV lines,” Carter orders.
You already have one. “16-gauge, left AC line.”
“I'm right.”
“Administer two liters of normal saline,” Carter continues.
The monitor emits a rapid beep.
Heart rate 138. Blood pressure dropping.
“Possible internal bleeding,” you murmur.
“Quick exam,” Carter says.
He grabs the ultrasound probe and spreads gel over the patient's abdomen.
A dark fluid appears.
“Positive findings for Morrison's pouch,” you say in a low voice.
Carter exhales. "Call the OR."
More stretchers arrive behind you.
Another victim. Then another.
The emergency room fills up instantly.
Screams. Monitors. Blood. Movement everywhere.
"Several traffic accident victims are arriving!" someone shouts.
You barely have time to breathe.
For the next hour, you don't stop for a moment.
Suture a scalp laceration.
A fractured radius is immobilized with a splint.
A chest tube is inserted in a patient with decreased breath sounds and tracheal deviation.
“Scalpel,” you say, making a small incision.
The forceps are inserted, spreading the tissue.
The air comes out with force.
"There he is."
The tube is inserted.
“Insert the tube. Connect to the vacuum cleaner.”
The lung expands again.
We move on to the next patient.
Your uniform is stained. Your hands hurt. Your mind is fueled only by adrenaline.
Across the room, Carter is working with the same speed: calmly, focusedly, and consistently.
You've always admired this look of his.
Even when everything seems to be falling apart, he stays grounded.
Attentive. Kind to patients. He speaks softly with families. He never raises his voice, yet everyone listens.
You catch him glancing at you, even if only for a moment.
He gives a little nod.
You nod in response.
Then you get dragged away again.
Time gets confused.
Eventually, the flood slows down.
The ambulances stop arriving. The emergency rooms calm down. The monitors return to working at a regular rate, instead of issuing frantic alarms.
Eventually, though you don't know how, you end up on the hospital roof, sitting on a low wall staring at the still-dark sky that in a few hours would turn a faded orange, overcome with exhaustion.
Your hands are shaking slightly.
"HEY."
Carter again.
Look up.
He is holding two cups of coffee in his hand.
"I thought you might find this useful."
“Can’t stay away from me today, huh?” a chuckle comes in response.
Take the coffee from Carter. "You saved my life."
He smiles slightly. "You handled the third trauma really well."
You shrug. "I think my brain has gone on autopilot."
"That's usually when you're at your best."
You laugh softly, looking down at your cup.
There's a pause. A silent pause.
Rare in the emergency room.
"Are you okay?" he asks.
You nod. "Yes. Just... tired."
“I thought you’d go back to your girlfriend after your shift and wake up romantically next to her,” you say in a fake romantic tone.
No one in the emergency room could stand Carter's girlfriend, especially the nurses, who certainly did nothing to hide it.
You don't particularly like her either, it's not that she's a good person towards you, but you're sure that the hatred you feel towards her is due to Carol and Chuny who keep badmouthing her nonstop behind Carter's back to make themselves heard.
He looks at you for a second longer than necessary. Then he gives a hint of a smile.
“Going home for about three hours and then coming back here to the ER to start another tireless shift? Nah, that wouldn't make any sense,” he comments, sipping his coffee.
He paused for a moment before continuing.
“And then we're not together anymore.”
You looked at him. He smiled again.
“We broke up a few days ago, I didn’t want to spread the word otherwise you know what a fuss Chuny would have made about how right I was to leave her.” He chuckles, and you with him.
“Well, I hope I can have the honor of breaking the new gossip to the girls,” you say, laughing.
“Come in, I have nothing left to lose, you've already stripped me of my dignity.”
Remain silent for a few minutes.
“Come on,” he says softly. “Follow me.”
You follow him back into the building, walking down the corridor, away from the noise. You go back down to the emergency room.
It took you a while to find an empty room with no patients in it where you could relax without worries.
The guard room is dimly lit, only by a small lamp. He closes the door softly behind you.
For the first time all night, all is silent.
You drag yourself to the bed, shoulders heavy, and sit cross-legged at the foot of the bed, staring at Carter leaning against the wall in front of you.
“Have you ever thought about quitting?” you ask suddenly.
He looks surprised. "To the emergency room?"
"Medicine."
He thinks about it.
"Sometimes," he admits. "But then... nights like this. When someone lives thanks to your presence."
Nod slowly.
You understand.
You've always done it.
The silence continues once again.
You can feel his presence next to you.
Heat.
Family.
Comforting.
Dangerous.
Because the truth is, at some point, your feelings stopped being simple.
It stopped being just a friendship.
You'd buried them. You'd ignored them. You'd told yourself it was just tiredness, just admiration, just habit.
But sitting here now, alone in the silence after the chaos, it's harder to pretend.
“You did a great job tonight,” she says softly.
You meet his gaze.
I feel a tightness in my chest.
“Thanks… Carter.”
He smiles: a small, tired, sincere smile.
And for a moment, neither of them moves.
As much as Carter tried to hide it, however, the face looked like someone who had just finished crying. His eyes were shining and his cheeks were redder than usual.
You're surprised you hadn't noticed it before, under the lights on the roof, and you only notice it now, with the moonlight delicately illuminating your colleague's features.
His smile was comforting as always, of course, but it also hinted at a cry for help that would soon shatter, revealing the true emotions Carter was feeling at that moment.
"You too..." you begin, faltering, stirring the coffee in the glass with slow movements of your hand since you don't have a spoon, "you don't look well..."
Carter sighs, looking down, one of his usual long breaths, the ones that precede a serious conversation. He runs a hand over his face, then over his hair, cursing himself as he squeezes his eyes shut.
"A child arrived, involved in the accident," Carter begins softly. "He reminded me of Bobby..."
*
The ambulance arrives at the emergency room, sirens still blaring.
It's 1:49 AM.
The rescuers quickly exit the vehicle, open the rear doors, and wheel out the pediatric stretcher.
On it is a child of about ten years old, very pale, thin, with his head slightly tilted to one side.
The portable monitor connected by the 118 operators can already be seen on his chest. The oxygen mask with a reservoir delivers 15 liters of oxygen per minute.
Carter rushes to the ambulance, rushing to carry the child inside on the stretcher.
One of the rescuers speaks as they rush into the shock room:
"Male, 10 years old, involved in a head-on car accident. Patient known for acute lymphoblastic leukemia, undergoing chemotherapy. Upon arrival, GCS 6, tachycardic, hypotensive. During transport, worsening, cardiac arrest two minutes ago. CPR is in progress."
Carter is already ready. Malik and Lydia are at his side. The ambulance stretcher is pushed alongside the emergency bed, and the child is quickly transferred while maintaining chest compressions.
The multiparameter monitor is connected:
• ECG: asystole
• Saturation: undetectable
• Blood pressure: undetectable
• Capnography: low
Carter takes the lead. But something in his head brings him back to his memories. Far from where he is now, or terribly close.
“Pediatric cardiac arrest. Starting pediatric ALS. Continue compressions. Bag-and-mask ventilation.”
Carol, begin deep, rhythmic chest compressions in the center of the chest, about 100-120/minute.
Another prepares the Ambu bag connected to oxygen. The child's chest rises with each breath.
The cervical vest is quickly removed to allow intubation while maintaining manual spinal stabilization.
"Let's prepare for intubation."
The anesthesiologist quickly checks the mouth: blood mixed with secretions. Immediate suctioning with a Yankauer tube. The laryngoscope is inserted. The vocal cords are visible.
"5.5 tube cuffed."
The endotracheal tube is inserted. The bag is ventilated. Capnography is connected.
"CO₂ present. Tube in place. Let's fix it."
Carter doesn't get distracted. He stays focused. He has to save that child. He has to save him at least. That's why he became a doctor. For him. For Robert.
No. This child is not his brother. It's Liam Taylor, if he understood the paramedics correctly. He was a child who was involved in the accident and who, unfortunately, had the same tumor as his brother.
Compressions are never interrupted for more than a few seconds.
A tibial intraosseous access is placed because the peripheral veins have collapsed. The intraosseous needle enters the proximal tibia. The line is connected.
"Adrenaline 0.01 mg/kg intraosseous."
The drug is administered. Resuscitation continues.
Meanwhile, Carter asks for additional information:
"Chest trauma? Blood loss?"
The rescuer remains passive, as if traumatized by all the deaths he'd seen that evening. "Probable abdominal trauma. Abdomen distended during transport."
The nurse quickly exposes the patient: his clothes are cut off.
Carter moves around the bed quickly, his mind replaying memories that at that moment he just wanted to burn into oblivion. "FAST ultrasound."
The ultrasound machine is brought in. Abdominal probe. Free fluid in the abdomen.
"Suspected massive internal bleeding."
Meanwhile, CPR continues.
“Stop compressions, check rhythm.”
Monitor: still asystole.
“Resume compressions.”
Second dose of epinephrine.
Controlled ventilation is initiated via tube. Capnography is very low, indicating minimal perfusion.
Chest palpation: reduced left-sided expansion.
“Possible pneumothorax. Prepare decompression.”
Large needle inserted into the second left intercostal space. No significant air escapes. We continue.
Third dose of epinephrine.
Time elapsed: 8 minutes.
The child remains in asystole.
Carter doesn't give up. He feels it. He sees it. Robert. On that bed. Dead.
Yet he's just a child; how can he save his brother? He can't. “Let's check his blood sugar.”
Blood sugar: 42 mg/dL.
“10% glucose bolus.”
It is administered.
Compressions continue. The operators rotate every two minutes to avoid fatigue.
Time: 12 minutes.
Monitor: persistent asystole.
Rapid crystalloid infusion is started under pressure.
The abdomen continues to distend. Massive hemorrhage is likely. The child, already immunosuppressed and anemic from leukemia, has very limited capacity to compensate.
Fourth dose of epinephrine.
Capnography drops further.
Time: 15 minutes.
The first blood unit arrives. It is connected.
Time: 18 minutes.
Still asystole.
Carter lowers his voice. “Let’s continue more cycles.” He couldn’t lose it. He could feel the beads of sweat trickling down his temple. His eyes filling with tears.
The compressions continue, rhythmic, constant. The room is silent, interrupted only by the metronome of the monitor and the sound of the Ambulance.
Time: 21 minutes.
Another rhythm check: asystole.
Fifth dose of adrenaline.
Carter observes the child. Waxy pallor. No response. Capnography almost flat.
Time: 24 minutes.
“Carter.” Carol’s voice echoes in Carter’s head. “It’s useless.”
Last cycle of resuscitation. No change.
Time: 27 minutes.
“Stop compressions. Final check.”
Monitor: Flat line.
Cardiac auscultation: absent.
Carotid pulse: absent.
Respiratory activity: absent.
Pupils: fixed and dilated.
Carter looks at his watch.
Silence in the room.
"Resuscitation time: 27 minutes. No return of spontaneous circulation. Maneuvers are stopped."
Brief pause.
"Death is declared at 2:16."
Compressions stop. The Ambu bag is slowly disconnected. The monitor continues to show a flat line.
The nurses gently remove the equipment. The tube is left in place until the paperwork arrives.
Outside the room, in another area of the emergency room, the mother is stable, still unaware. The father has already been transferred to intensive care.
The shock room slowly falls silent again. The staff leaves one at a time, after covering the child with a sheet.
Carter leaves first. He locks himself in the bathroom after removing his gown. He was about to explode. He hadn't been able to save him.
Again.
*
"You know, yesterday was his birthday," Carter comments with a hint of a smile as he looks you in the eye again.
"They were returning from camping with his parents. His mother told me; she's hospitalized here in the emergency room. Luckily, she's currently stable, but she hasn't been told the news of her son's death yet."
"The father was transferred to the emergency room a little while ago, before I came to you on the roof."
He remains silent.
You already knew what was going through Carter's mind at that moment. He didn't say it in his story, but you knew him very well. Even if he didn't say it explicitly, you knew who he was referring to.
Robert Carter. Bobby, Carter's brother. Died when he was just a child of leukemia.
One evening, after a few beers, Carter confessed to you that he had started thinking about becoming a doctor after his brother's death, and that he wanted to save as many lives as possible since he hadn't been able to save his brother's.
If you don't know Carter, but only his family, you would never imagine the empathy this man feels for his patients every day and all the commitment he puts into saving one more life every day.
Furthermore, Carter knew very well that you had also had the same problem: acute lymphocytic leukemia, with the only difference being that Bobby had had acute promyelocytic leukemia, one of the toughest.
Knowing his history, you'd never wanted to say a word about your health issues as a child, but you'd inevitably discovered it at a mutual friend's party.
*
You'd already sent jinxes to everyone at that party.
To think you didn't even want to go, but here you were, locked in the upstairs bathroom, away from all those drunk people, trying to wash a soda stain off your shirt that someone had unfortunately spilled on you.
While you were struggling with your shirt, trying to keep warm since you were left in only your bra and shorts, the bathroom door swung open.
Carter stood still in the doorway, staring at you with a shy smile in his eyes. His gaze was sculpted on your body, mesmerized by your curves.
You looked at him, red in the face, wanting to yell at him to go away, to wait until he was finished, but the only sound you could hear was the monotonous sound of the water running from the faucet.
Carter continued to stare at you. Then his gaze was drawn to something else.
Slowly, but not very discreetly, I lowered my gaze to your chest, and as much as you would have much preferred him staring at your breasts, you knew that wasn't what had caught his attention.
In fact, you had several scars on your chest, from years ago now. They weren't invisible, but only the most attentive noticed.
"My brother..." Carter continued to stare at the scars, "He had scars similar to yours." He spoke harshly, his hand tightening around the doorknob.
"I was two years old..." That was all you managed to say after the silence fell on the room.
He looked up, staring into your eyes, seeming betrayed, perhaps by the fact that you'd never told him.
After a few seconds, he seemed to regain his composure, even though you knew he simply needed to get away from that situation as quickly as possible.
“Sorry…” he stammered in a whisper, then walked out of the bathroom, closing the door behind him and leaving you alone in the cold bathroom to wash that stupid shirt (which you would eventually throw away when you got home).
At the end of the party, you stayed a few minutes longer to help the owner of the house clean up the mess that had been created. You thought everyone had gone to their lives, that you were the only one left besides the owner, but instead, while you were in the kitchen clearing away the leftover snacks, someone approached you, leaning silently against the counter.
“I didn’t know,” Carter began, staring at you.
“I never told you.”
“Was it painful?” he asked with the air of a beaten dog, as if he’d done nothing but curse himself the rest of the evening.
“That was a while ago,” you commented.
He looked down, and you realized that your responses might have given the impression that you were angry with him. So you looked up and met his eyes, smiling, trying to ease the tension between you.
“But I'm fine now!”
He smiled back at you. “I see you're fine.”
The discussion remained there, frozen in that room, in that house. It was never resumed. A curiosity. An argument. One question too many. Nothing. A taboo.
But as time passed, you began to notice that Carter seemed increasingly protective of you, not in a toxic way, but like a presence, that even if you don't want him around at that moment, he is available and present.
*
“If you want, for any upcoming traumas, I can take care of them,” you say softly, breaking the silence that had slowly formed between you.
Carter approached you, then, trying not to bump into you, threw himself onto the bed, his head turned toward the ceiling, his eyes tired.
"No one serious has arrived yet unless they call us..." he whispered, looking at you. "Stay with me."
More than a request, it seemed like a plea, something he knew full well you, even if you wanted to, wouldn't be able to say no.
Carter was your friend, one of your dearest friends; there would be nothing wrong with you dozing for a few minutes next to him on the hospital bed.
But those conflicting feelings, of friendship and love, prevented you from thinking clearly, especially since you now knew he had broken up.
The boy who from day one had struck you with his intelligence and his empathy, kindness, and affection, was lying next to you, drained of all strength, begging you not to leave, to stay next to him, perhaps with your back to his chest.
Your cheeks flushed at the thought.
Carter hesitated. Something in his eyes faded.
"Wrong idea, sorry, if you don't like it, you can go. I don't blame you if you prefer to get ahead with the paperwork." He looked disappointed, sad, even though he was trying hard to manage a friendly smile.
"I can stay if you like," you said quickly, looking at him.
He turned his eyes to you, looking you over gently with a genuine smile plastered on his face.
“Do I please? Oh God, yes please… I need you now…”
That last sentence left you gasping as you slowly lay down next to him. His arm held firmly on the pillow, not moving away for anything in the world, so you were forced to rest your head on it.
You could feel his warmth enveloping you completely; it wasn’t the first time you’d been so close to him, but a hug was one thing, lying together on a bed you’d always thought was extremely small was another.
His breath rested warmly on your hair-covered neck, your legs pressed together.
“So… you broke up…” you said in a joking tone.
You could feel him smile.
“I realized I no longer felt anything for her, and that I was actually running away from the person I truly love.” He smiled softly, stroking your hair lightly.
You blushed under his touch.
“Well, this girl must be amazing for you to leave that rich, plastic-clad girl,” you laughed.
“She didn’t have plastic surgery,” Carter commented after you, joining in the laughter.
Then, outside, a monitor beeps again.
The emergency room will call you back.
And the moment is shattered.